Urinary Tract Infection: Asymptomatic Bacteriuria: Treatment
Asymptomatic bacteriuria should not be treated with antibiotics in LTCF residents
- Several studies have looked at the role of antibiotic treatment in long-term care patients with asymptomatic bacteriuria, and have consistently found no benefit.
- Summaries of three selected studies:
- Mortality and infectious morbidity is similar with or without treatment in elderly institutionalized men, and while bacteriuria can be transiently eliminated in some patients, it usually recurs within several weeks. (1)
- In elderly institutionalized women, monthly screening and antibiotic treatment of asymptomatic bacteriuria had no impact on genitourinary morbidity and mortality, and was associated with an increased risk of antimicrobial side effects and future isolation of resistant organisms. (2)
- Eradicating bacteriuria has no short-term benefits on severity of chronic urinary incontinence. (3)
- There is some thought that asymptomatic bacteriuria by certain strains of bacteria may be protective against the establishment of more virulent bacterial strains that could cause invasive infection. The use of these less virulent strains to prevent invasive infection is being investigated. (4)
Asymptomatic bacteriuria should not be treated with antibiotics in diabetics
- Treatment results in short-term clearance of bacteriuria, but has no impact on prevention of symptomatic infection, complications, or hospitalization. (5)
Antibiotic treatment of asymptomatic bacteriuria is only beneficial in selected populations (6)
- Pregnant women - approximately 10% of pregnant women will develop asymptomatic bacteriuria. Asymptomatic bacteriuria is associated with increased risk for pyelonephritis, intrauterine growth retardation, and low-birth-weight infants. Therefore, screening and treatment is recommended.
- Persons undergoing invasive urologic procedures - there is significant risk of post-procedure bacteremia and sepsis in patients with bacteriuria undergoing invasive urologic procedures (where mucosal bleeding is anticipated). Antibiotic treatment has proven to be beneficial in reducing this risk, and is recommended.
- Recent (< 6 months) renal transplant recipients (possible benefit) - some experts recommend screening for and treating asymptomatic bacteriuria in this population, though the evidence is not clear.
References:
1. Nicolle LE, Bjornson J, Harding GKM, et al. Bacteriuria in elderly institutionalized men. NEJM 1983;309:1420-6.
2. Nicolle LE, Mayhew JW, Bryan L. Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized women. Am J Med 1987; 83:27-33.
3. Ouslander JG, Schapira M, Schnelle JF, et al. Does eradicating bacteriuria affect the severity of chronic urinary incontinence in nursing home residents? Ann Intern Med 1995;122:749-54.
4. Darouiche et al. Bacterial Interference for Prevention of Urinary Tract Infection: A Prospective, Randomized, Placebo-Controlled, Double-Blind Pilot Trial. Clin Inf Dis 2005; 41:1531-34.
5. Harding GK, Zhanel GG, Nicolle LE, et al. Antimicrobial treatment in diabetic women with asymptomatic bacteriuria. NEJM 2002; 347(20):1576-83.
6. Nicolle LE, et al. Infectious Disease Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults. Clin Inf Dis 2005;40:643-654.
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